Myocardial Staining (TMPG 1) Post-Stent in AMI
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Myocardial Staining (TMPG 1) Myocardial Staining (TMPG 1) Post-Stent Post-Stent in AMI in AMI 0 10 20 30 Pre-Stent Post-Stent p = 0.004 n = 118 n = 118 CM Gibson, J Thrombolysis & Thrombosis, 2002 in press 13.5% 28.6% % TMPG 1
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Myocardial Staining (TMPG 1) Post-Stent in AMI. p = 0.004. 28.6%. % TMPG 1. 13.5%. n = 118. n = 118. CM Gibson, J Thrombolysis & Thrombosis, 2002 in press. Intracoronary Devices and Embolic Potential. Topol, E. Circulation. 2000;101:570-580. - PowerPoint PPT Presentation
Transcript of Myocardial Staining (TMPG 1) Post-Stent in AMI
Myocardial Staining (TMPG 1) Myocardial Staining (TMPG 1) Post-Stent in AMI Post-Stent in AMIMyocardial Staining (TMPG 1) Myocardial Staining (TMPG 1) Post-Stent in AMI Post-Stent in AMI
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p = 0.004p = 0.004
n = 118n = 118n = 118n = 118
CM Gibson, J Thrombolysis & Thrombosis, 2002 in pressCM Gibson, J Thrombolysis & Thrombosis, 2002 in press
13.5%13.5%
28.6%28.6%
% T
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% T
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G 1
Topol, E. Circulation. 2000;101:570-580. Topol, E. Circulation. 2000;101:570-580.
Intracoronary Devices and Intracoronary Devices and Embolic PotentialEmbolic Potential
Intracoronary Devices and Intracoronary Devices and Embolic PotentialEmbolic Potential
Intracoronary Serotonin Release After StentingIntracoronary Serotonin Release After Stenting
Leosco et al, AJC 1999;84:1317-1322 Leosco et al, AJC 1999;84:1317-1322
Stenting causes greater serotonin release than PTCA
Stenting may cause greater arterial damage, greater plt. deposition, and greater plt. activation leading to vasoconstriction
Stenting causes greater serotonin release than PTCA
Stenting may cause greater arterial damage, greater plt. deposition, and greater plt. activation leading to vasoconstriction
Impact of IC Adenosine & GP 2b3a Inhibitor on TIMI Myocardial Perfusion Grade
Impact of IC Adenosine & GP 2b3a Inhibitor on TIMI Myocardial Perfusion Grade
Post PTCAPost PTCA Post PTCA + AdenosinePost PTCA + Adenosine
DistalLAD with no blush
DistalLAD with no blush
DistalLAD with
TIMI 3 Grade Blush
DistalLAD with
TIMI 3 Grade Blush
(DSA = 0.1 Gray)(DSA = 0.1 Gray) (DSA = 5.2 Gray)(DSA = 5.2 Gray)
CM Gibson 2000CM Gibson 2000
Impact of IC Adenosine on Clinical & Electrocardiographic Impact of IC Adenosine on Clinical & Electrocardiographic Outcomes in the Setting Primary PTCAOutcomes in the Setting Primary PTCA
Impact of IC Adenosine on Clinical & Electrocardiographic Impact of IC Adenosine on Clinical & Electrocardiographic Outcomes in the Setting Primary PTCAOutcomes in the Setting Primary PTCA
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% Developing Q Waves
% Developing Q Waves
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% Death, MI, CHF, Recurrent Angina% Death, MI, CHF, Recurrent Angina
p < 0.02p < 0.02 p < 0.04p < 0.04p < 0.03p < 0.03
Marzilli et al, Circulation 2000; 101:2154-2159Marzilli et al, Circulation 2000; 101:2154-2159
N=27N=27 PlaceboPlacebo N=27N=27 Adenosine 4 mg in 2 ml via central lumen of PTCA balloonAdenosine 4 mg in 2 ml via central lumen of PTCA balloon
% o
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% o
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Hypothermia in MI Reduces Infarct SizeHypothermia in MI Reduces Infarct SizeHypothermia in MI Reduces Infarct SizeHypothermia in MI Reduces Infarct Size
No CoolingNo Cooling CoolingCooling
Non-culprit CTFCs Improve Following PCI of the Culprit ArteryNon-culprit CTFCs Improve Following PCI of the Culprit ArteryNon-culprit CTFCs Improve Following PCI of the Culprit ArteryNon-culprit CTFCs Improve Following PCI of the Culprit Artery
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CTFC > 28 CTFC < 28-2
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• Dilating the culprit stenosis speeds up flow in the uninvolved artery (non-culprit artery) in acute coronary syndromes
• Dilating the culprit stenosis speeds up flow in the uninvolved artery (non-culprit artery) in acute coronary syndromes
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N = 134N = 134
N = 228N = 228
- 0.7 + 8.6- 0.7 + 8.6
10.4 + 16.010.4 + 16.0
P < 0.0001P < 0.0001
Gibson CM et al, Am J Cardiol 2000Gibson CM et al, Am J Cardiol 2000
Alpha Adrenergic Blockade Improves Recovery of Myocardial Perfusion After Stenting in AMI
Alpha Adrenergic Blockade Improves Recovery of Myocardial Perfusion After Stenting in AMI
Gregorini et al, Circulation 1999; 99: 482-490Gregorini et al, Circulation 1999; 99: 482-490
Alpha Adrenergic Blockade Improves Recovery of Myocardial Perfusion After Stenting in AMI
Alpha Adrenergic Blockade Improves Recovery of Myocardial Perfusion After Stenting in AMI
Gregorini et al, Circulation 1999; 99: 482-490Gregorini et al, Circulation 1999; 99: 482-490
Downstream TargetsDownstream TargetsDownstream TargetsDownstream Targets
• Large embolii: Filters• Small embolii (thrombii): Filters & GP 2b3a
inhibitors• Vasoconstrictor release: GP 2b3a inhibitors• Spasm: Adenosine, Ca channel blockers,
alpha blockers, avoid over sizing with PCI, high pressure inflations, serotonin inhibitors, endothelin inhibitors
• Endothelial & Myocardial swelling: Ca channel blockers, hypothermia, DHEA, Na / H pump inhibitors, anti-inflammatory approaches
• Large embolii: Filters• Small embolii (thrombii): Filters & GP 2b3a
inhibitors• Vasoconstrictor release: GP 2b3a inhibitors• Spasm: Adenosine, Ca channel blockers,
alpha blockers, avoid over sizing with PCI, high pressure inflations, serotonin inhibitors, endothelin inhibitors
• Endothelial & Myocardial swelling: Ca channel blockers, hypothermia, DHEA, Na / H pump inhibitors, anti-inflammatory approaches
